Community Violence Exposure and PTSD Among Young Adults Living in Public Housing: A Mixed Method Analysis

Background and Purpose: Community violence continues to be a significant problem in American cities. Young adults are more highly exposed to community violence than any other age group (Truman, Langton, & Planty, 2013) and are particularly vulnerable to developing mental illness including PTSD (Institute of Medicine, 2014). Recent research has suggested that a five-factor model of PTSD consisting of anxious arousal, dysphoric arousal, re-experiencing, numbing, and avoidance factors may be more valid than previously-supported three and four-factor models (Elhai et al., 2013). The five-factor model has yet to be tested in a sample of young adults highly exposed to community violence. The purpose of this study was to describe the extent of community violence exposure and PTSD in a sample of young adults living in urban public housing and to test the factor structure of PTSD in this sample, which may inform social work practice and policy.  

Methods: This study used a convergent parallel mixed methods design. Area sampling was employed. All participants were young adults (18 to 30) living in public housing developments in a Northeastern US city. Participants were recruited using a combination of random sampling of apartment units, fliers hung in the neighborhood, and snowball sampling. Quantitative and qualitative data were collected at one time-point and analyzed separately. Quantitative data were analyzed using Structural Equation Modeling including a confirmatory factor analysis. Qualitative data were analyzed by two coders applying thematic analysis and the constant comparative method. Mixed method analyses were conducted after quantitative and qualitative analyses were completed using a side-by-side table, examining convergence and divergence between the sets of data.

Results: The sample includes 121 young adults (Mean age = 24, 62% female, 47% Latino, 28% Black, 11% Multiracial, 14% Other). Descriptive statistics indicate these young adults have experienced frequent community violence exposure, with 99% hearing about violence, 89% witnessing community violence, and 60% being personally victimized. Eleven percent had been shot or stabbed themselves. Nearly 12% met criteria for PTSD. Among the five factors of PTSD tested, anxious arousal and avoidance emerged as occurring most frequently, more than twice a month on average. Confirmatory factor analysis indicated support for a three-factor structure of PTSD rather than five, including avoidance, anxious arousal and a latent variable composed of symptoms of numbing, dysphoric arousal, and re-experiencing. Qualitative data indicated that anxious arousal (hypervigilance) and avoidance were commonly experienced. Mixed method analyses revealed convergence around the salience of hypervigilance and avoidance symptoms in the sample.

Conclusions and Implications: Community violence exposure in this sample is startlingly high, and PTSD rates are nearly twice the national average. In the context of neighborhood violence, it may be that avoidance and hypervigilance become most salient because they are instrumental in keeping young people safe when confronted with ongoing danger; said another way, they are protective. Interventions to help young adults differentiate between real and perceived danger and engage in safety planning are called for, and theoretical implications of the three-factor model of PTSD that emerged from these data will be discussed.